Hi Dr. Hall,
I’ve had teeth problems my whole life. I have chipped missing and discolored teeth. It seems like no one wants to help me fix them. The only thing the dentist wants to do is partial dentures. I guess I could do that but I would really like something more permanent in the front. I’ve tried to talk to him about it and he doesn’t say anything. Finally he said the way your teeth are we can’t do anything else but take out the bad teeth and do partials. I thought with all the stuff dentists had they could fix anything. My question is if you have really bad teeth can they still get fixed? Plus why do dentists suggest partials instead of fixing your teeth? By the way I’m 35 feel like I’m to young for full partials.
– Theresa from New York

Theresa,
Dentists vary a lot in their interest in saving teeth. In my practice, I was passionate about that and rescued a number of teeth that other dentists said were hopeless teeth. Almost every tooth that has tooth decay or is broken can be fixed, but there are many dentists who don’t want to go to the trouble of saving them. And for missing teeth, if you’re willing to pay for dental implants, that is by far a better way to treat missing teeth than removable partials.

Also, when you have a mixture of missing teeth, chipped teeth, and discolored teeth, as you have explained, there are usually a number of different ways to fix them. But some of those ways require newer technologies such as dental implants or dental bonding and some dentists aren’t comfortable doing those.

You can be grateful, at least, that your dentist isn’t willing to go out of his comfort zone. Some dentists will do that, to please the patient or to avoid losing the patient, sometimes with disastrous results.

Just get a second opinion. Look for a dentist with a similar philosophy to yours. Again, don’t try to push any dentist out of his or her comfort zone. Listen to what they recommend, gently prod to see if they are giving you all the options, ask what they recommend, and then decide if that’s what you want to do. If you do want to save the teeth, you want a dentist who enjoys doing that, because they will have a passion and practice in doing that successfully. And for a dentist who is good at placing dental implants, that is the thing they will certainly prefer doing for you and will likely be the first thing they recommend.

Good luck,
Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

Dr. Hall,
I recently broke my front tooth off, right below the gumline. I am looking for the cheapest, easiest, fastest way to fix this. I am 100% against implants.
– Harley from Nebraska

Harley,
Are you really asking me this? I don’t think you really mean the question the way it came out.

For the cheapest, easiest, fastest way to fix your broken front tooth, go to Walmart, buy a tube of Superglue, and glue your tooth back in. Cheap, easy, fast.

Problem is, the repair will only last for a couple of days. But long-lasting wasn’t on your list of requirements.

Another solution, not as cheap but also easy and fast and, as a bonus, long-lasting, would be to have a dentist bond a glob of composite onto the broken part of the tooth, making a little mound. That would last a long time. It wouldn’t look very good, though, but looking good wasn’t on your list.

Let’s re-order your priorities and make it first, something that will look good, and second, something that will hold up long-term. To accomplish that, there are two options. And neither one is cheap, easy, or quick.

It could be possible to repair the tooth by placing a crown on the remaining root. But that would only work if there isn’t a lot of stress on this tooth. If you have a deep overbite or even just a strong bite, it would be hard to get the crown to stay on. But if you have a gentle bite, it could work. You would need to have a root canal treatment on the remnant of your tooth, then have a good, strong post that’s not completely rigid. Either a carbon fiber post or a fiberglass post would work. The stress on a front tooth is mostly lateral. If you have a rigid metal post going down into the root and then put stress on the crown of the tooth, that stress will transfer to the root through the post and tend to cause a root fracture. If the post has a little flexibility to it, however, it will not transfer stress to the root and thus not tend to fracture the root.

And better yet, I would place two posts side by side, to help resist rotational forces that would tend to weaken the bond to the tooth over time. All posts are perfectly round, so any twisting force on them will tend to dislodge them.

However, if there is any significant stress on this tooth, the only solution that will hold up over a long time would be replacing the tooth with a dental implant. This could cost twice as much as a root canal, posts, and crown, and would take substantially longer because of the healing time required. But it would look good and last much longer. Doing the crown first could have you ending up with the dental implant eventually because the crown would fail.

Bottom line—sometimes the cheapest dental solution is the most expensive, the quickest solution takes the longest, and the easiest solution is the most complicated. It’s generally best to just fix it right in the first place and then be done.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

Dr. Hall,
I had a tooth extracted on Wednesday and last night when I was cleaning out the hole from debris, I noticed that I still have 2 roots left that weren’t extracted. Will that cause a problem for an implant? Do they need to be extracted? Why would the roots be left and not extracted as well?
– Shay from Utah

Shay,
I have a couple of things to say about your question.

First, how is it that you know that two roots from this tooth are left and weren’t extracted? Teeth with multiple roots are molars, and seeing that far back in your mouth is kind of tricky, especially after an extraction. Are you sure this wasn’t just more debris stuck down in your socket that you didn’t quite get cleaned out?

But let’s assume that the dentist did leave a couple of roots behind. In some situations that might be the best thing to do, but the dentist should always inform the patient that this was done. There could be some risk involved. Usually, where this is legitimate to do, they are not complete roots but root tips that are in a high-risk position so that retrieving them could puncture the sinus or risk damage to a nerve. And yes, if you are going to have a dental implant, these roots will need to be removed. I would go back to the dentist and ask that he or she take care of this and get those roots out, or pay an oral surgeon to get them out. The sooner this is done after the extraction, the easier.

It is hard for me to imagine, assuming that these roots were indeed left, that the dentist would not know that roots were left. We always, after an extraction, examine the tooth to make sure it is intact and if not, we go back and make sure to retrieve all the pieces. Furthermore, you know when you break off a root during an extraction. There is a definite snap. When I was a practicing dentist, I had to have premolars extracted because I was getting braces. The dentist who did this broke off roots and, as the patient, I knew exactly when the roots broke. But retrieving roots and root tips is a skill with which not all dentists are comfortable, and they can sometimes, for dentists who are not good at this or who don’t have the proper instruments to accomplish this, be extremely time-consuming and can ruin a schedule, causing other patients to have to wait, besides causing great beads of sweat to form on the dentist’s brow.
– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

June 7, 2012

Dr. Hall,
I’ve been to two different dentists lately because one of my front teeth, that had previously been bonded, broke almost completely off. Both dentists wanted to pull most of my front teeth and get a PARTIAL! I am a single 35 year old woman and the thought of having removable teeth horrifies me! Please help! Money is not a concern. What can I say to get it through a dentists head that I DO NOT want my teeth pulled?? My teeth do not hurt in anyway, even the one that chipped off doesn’t hurt.
– Donna from Kentucky

Donna,
Don’t try to convince either of these dentists to save your teeth. That would be a mistake, even if you could convince them to try. Dentists vary greatly in their commitment to saving teeth. If a dentist doesn’t believe in saving teeth, there is a reason for it. Often it’s that he or she just doesn’t want to bother. It’s riskier to try to save teeth – you might not be successful. And pulling teeth and replacing them with a partial denture is much easier. Or it could be that the dentist doesn’t have very good skills for saving teeth, so I wouldn’t try to push them at all in this.

I wonder, when I get a question like yours, if the situation isn’t that the teeth are truly hopeless. But I’m inclined to believe, in your case, that is not the case, for two reasons. First, you seem very committed to saving your teeth, so I can’t believe that you’ve been neglectful. And you mention that money is not a concern. And then both dentists are recommending removable partial dentures, which is a really low-class way to fix your mouth, even if the teeth were hopeless. So that suggests to me that these dentists are both looking for easy solutions. Why no mention of dental implants, which is a far superior way to replace missing teeth?

Have you checked with Dr. —? [the mynewsmile.com recommended dentist closest to where Donna lives] That’s where I would recommend going. [He] believes in first class solutions. From what I know of [him], I think that [he] would try to do whatever [he] could to save them. To save yourself some money and some time, I would call the office and be very up front about what you want – you want a dentist who believes in saving teeth. And if they tell you over the phone that [this dentist] is strongly committed to saving teeth, tell them that Dr. David Hall recommended [him] and said he thought [he] would agree to a quick complimentary meeting where you could ask [him] about that, face-to-face. If you like what you hear, you could then schedule the exam.

Your case doesn’t sound simple. This front tooth, if it had been bonded, must have broken before. And now if it has broken almost completely off, that may mean that you have a very strong bite, which would require extra expertise to get your teeth fixed so that they will withstand those biting pressures. You really need to get away from dentists with this small-town-dentistry mentality and into a higher level of care. And by small-town-dentistry mentality, I don’t mean to imply that dentists from small towns aren’t good dentists. I have a great affection for small towns and some small-town dentists are among the best in the country. I refer to a mentality of doing patchwork dentistry, or low-tech dentistry, or avoiding difficult things.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

August 16, 2011

Good day Dr. Hall,
I am 24 years old and broke off at least 1/3 of my left front tooth when I was 21 or 22. I was in France at the time and had to have an emergency root canal as the nerve had been exposed. When I got back to England (where I lived then), I went straight to my dentist who drilled out the filling to check the work. He concluded it was good, refilled it and later put a crown on it. This was fine for a long time, with no pain.

In November 2010, after I moved to Georgia, the crowned tooth became excrutiatingly sensitive to hot and cold, and occasionally ached when not eating or drinking at all. So after a couple of months, the pain had become far less intense and only now sensitive to very cold. I decided I would still go and have it checked, after an x-ray and some wiggling of the tooth my dentist could not tell what was wrong, so referred me to an endodontic specialist. The specialist said he thought the symptoms were coming from the tooth next to it as I have been putting pressure on that tooth in my sleep.

So nothing has been done to the crowned tooth and the wiggling of the tooth which they both did actually made the pain come back again. It is still bothersome and I am very worried. The pain is starting to get a little worse again, now. With both dentist and specialist saying they can’t see anything wrong on x-rays, and I have no pain when they tap the tooth, I am at a loss. I fear that I will eventually lose the tooth if nothing is done to solve whatever is wrong. What do you think this could be? I find it strange that the tooth gave me no trouble for over a year and then all of a sudden became unbearably sensitive. I very much look forward to your reply, and thank you in advance for your advice.

Kindest regards,
Danielle from Georgia

Danielle,
I’m not sure why there is so much puzzling about this tooth. This isn’t that difficult a diagnostic situation.

Let me clarify a couple of points to bring some sense to what has happened to you..

First, I’m understanding you had a root canal treatment on your left front tooth 2 or 3 years ago. That removed the nerve from the tooth, so there is no way it could have any sensation to hot or cold, unless the root canal treatment wasn’t really done. It is very rare for this upper front tooth to have any extra canals or other strange anatomical features that a dentist might miss in doing a root canal treatment.

Second, not seeing anything on the x-ray is no great mystery. When the pulp of a tooth is inflamed, it doesn’t show up on the x-ray until the inflammation progresses to infection and the infection begins to leak out the end of the tooth into the bone. It also isn’t sensitive to tapping until that happens.

Going back to the original accident that caused your left front tooth to fracture. As large as the fracture was, there had to be some trauma to the teeth next to it. So for one of these teeth to be acting up at this point is not the least unexpected. I have seen that before where a tooth has been traumatized and it is fine for several years and then begins to act up.

If the pain is pretty much gone now, it could mean one of two things. Either the tooth has recovered, or the tissue inside the tooth is dying. If it is dying, that will show up on the x-ray in time, plus the tooth will turn darker. So as long as it is not hurting, there is no great urgency and I would leave it alone and get an x-ray at your next regular check-up and see what it shows. If it shows nothing, count your blessings, but have the tooth x-rayed again every few years, just to be sure. If the tissue does die, which is what will probably end up happening, it means that you’ll need another root canal treatment and a crown – it’s not that difficult to fix.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.